Organization
RANDAL W ELLIS DMD PLLC
Active
Other names
Ellis Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
RANDAL W ELLIS DMD (DENTIST/OWNER)
(360) 592-1100
Entity
Organization
Contact information
Practice address
3739 MT BAKER HWY, EVERSON, WA 98247-9406
(360) 592-1100
(360) 592-5067
Mailing address
PO BOX 608, DEMING, WA 98244
(360) 592-1100
(360) 592-5067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00008470
WA
Other
Enumeration date
08/14/2006
Last updated
05/03/2012
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